DISCRETIONARY GRANT
2014/15
LEARNERSHIP APPLICATION FORM
Due date: 22 September 2014 at 16h00
Applications are to be submitted to the CATHSSETA,
dg2@cathsseta.org.za
OR
Hand delivered Couriered for the attention of:
Chief Executive Officer:
Discretionary Grant Application 2014/15 window 2
1 Newtown Road
Killarney
For CATHSSETA only
Date Received
Reference Number
DG2014/L
Date Processed
Training Provider
APPLICANT
Employer
Lead Employer
Please mark with cross (X)
SUBMIT ONE FORM FOR EACH APPLICATION
PLEASE ATTACH A LIST OF HOST EMPLOYERS IF APPLYING AS LEAD EMPLOYER
ALL APPLICANTS MUST COMPLETE ANNEXURE C OF THE APPLICATION FORM
2
SECTION A: APPLICANT DETAILS
Name of Organisation
______________________________
New Organisation
Yes/No
Physical address of
applicant
Postal address of
applicant
Province of Applicant’s
Head Office
Period of company
existence
2–5
years
Less than
1 year
levy Payer
6 – 10
years
More than
10 years
Non Levy payer
Organisation Category
Skills Development Levy
Number
Name
Designation
Applicant
Contact person
Tel Number
Cell Phone Number
Fax number
Email Address
Business Size
Size of business and
number of employees
Specify exact number of
permanent employees
0–9
10 – 49
50 – 149
150 – 999
1000 – 4999
5000 +
Micro
Small
Medium
Large
Macro
Mega
Main activities of
business
Chamber Focus
No. of
permanent
employees
SIC CODE:
Arts, Culture &
Heritage
Conservation
Gaming &
Lotteries
Hospitality
Sport,
Recreation
& Fitness
Travel &
Tourism
3
SECTION B: PROJECT/GRANT DETAILS
Learnerships Name & ID eg.
25Q250029722405
Qualification Title
- NQF Level
Number of Credits
Qualification linked to which Occupation
(Ref. To Annexure F CATHSSETA
Discretionary Grants Policy for list of
Priorities)
Accredited Provider Details (Name)
Name of Employer
Provider Accreditation End/ Expiry Date
Target Provinces(give learner
breakdown in numbers)
EC
FS
GP
KZN
LIMP
MPU
NC
NW
WC
Y
Y
Y
Y
-
M
M
-
D
D
Y
Y
Y
Y
-
M
M
-
D
D
Total Number of Beneficiaries &
Geographical Spread
Number of Employed beneficiaries
Number of Unemployed beneficiaries
Project Duration
Start Date
End date
Total Amount Applied for
Total Applicant’s Contribution
4
NB!!! It is compulsory to complete section C of this application
SECTION C: PROJECT/GRANT PLAN (TO BE COMPLETED FULLY)
BACKGROUND
PURPOSE
PROJECT OBJECTIVES
Benefits for the CATHSSETA:
Benefits for the sector:
Benefits for the organisation:
Benefits for the recipients
IMPLEMENTATION PLAN
Phase 1: Pre-implementation
Phase 2: Implementation
Phase 3: Closeout
5
No
Milestone
Activities/Description
1.
Pre-Implementation Phase
Responsible person
Time frame


2.
Implementation Phase


3.
Close-out Phase


Cost Item
Cost Description
Estimated Cost
Cost Phase 1: Pre-implementation

Cost Phase 2: Implementation

Cost Phase 3: Close-out

Total Intervention Cost
The following areas must be covered in the implementation plan:
1. Unit standards per quarter
2. The workplace experience and learning environment per unit standard or
cluster of unit standards
3. Provider roles & responsibilities
4. Employer roles & responsibilities
5. Learner support outlined
6. Time period when workplace assessment will take place
7. Indicate period when summative assessment will take place
8. Workplace mentors and coaches are identified and listed in implementation
plan
9. Workplace assessors are identified and listed in implementation plan
10. Possible Planned Dates for Learnership Induction
6
SECTION D: AUTHORISATION
Name of Organisation Executive
Position of Organisation Executive
Signature of Organisation Executive
Signature of Training Committee chairperson
(Where relevant. In case where Organisation has more than 50 employees)
Date of Submission
Organisation stamp